Purpose & Patient Population :

To update previously published guidelines from 2000 for the prevention of infection in patients receiving any type of hematopoietic stem cell transplantation (HSCT). Patients analyzed were adults and pediatric populations receiving allogeneic or autologous HSCT.

Type of Resource/Evidence-Based Process:

The resource was presented as an evidence-based guideline. An international group of experts from identified professional organizations reviewed and graded evidence and developed recommendations.

Phase of Care and Clinical Applications:

Patients were undergoing multiple phases of care.

The study has clinical applicability for pediatric populations.

Results Provided in the Reference:

The volume and highly specific process were not discussed.

Guidelines & Recommendations:

Recommendations were made, and possible opportunistic infections at pre-engraftment, post-engraftment, and late phases of HSCT were identified. Recommendations included

Antibiotic and antifungal prophylaxis.

Consideration of hepatitis B vaccination for those who are hepatitis B-naïve and for donors and recipients of allogeneic transplantation prior to cell collection.

Varicella-zoster virus (VZV) vaccination for people in close contact and healthcare providers who are seronegative at least six weeks prior to HSCT contact.

Measles, mumps, rubella (MMR) vaccination of those in close contact and healthcare workers.

MMR patient vaccination for select groups of patients.

Policies that prohibit visits or close contact for people with respiratory or flu-like symptoms.

Education to reduce exposure to potential opportunistic infections.

Pneumococcal vaccination, annual influenza vaccination, hepatitis B vaccination, consideration of hepatitis A vaccination for people in areas where hepatitis A is endemic, diphtheria vaccination for appropriate age children according to general immunization guidelines, and pertussis reimmunization of appropriate patients.

Timing and appropriate individuals for various immunizations are important considerations, and it is recommended that users of this information refer to the full report. Overall, use of live vaccines is contraindicated for these patients; vaccination is contraindicated in those with chronic graft-versus-host disease or when patients are still immunosuppressed.

Limitations:

Some recommendations were based on expert opinion due to lack of research evidence in the area.

Nursing Implications:

Specific interventions for prevention of infection among HSCT recipients is a complex field, and healthcare providers who work with these patients need to be aware of current knowledge. Evidence in this area continues to evolve as HSCT techniques change and further evidence is gained regarding the immediate and long-term effects of HSCT.